Job description

Member Services Manager

Only open to candidates in California

Manage the Member Services Department which provides customer support to members of the following programs: Medi-Cal, HealthWorx, Healthy Kids, and San Mateo County ACE.

Position overview

• Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner. Work with the entire Unit to continuously measure and improve the performance. Schedule staff to ensure adequate level of service to members, adjust schedules, and ensure backup coverage as needed.
• Oversee and/or manage selection and orientation process for new employees and provide on-going staff development.
• Collaborate with CSO on the development, monitoring, and control of departmental budget and resource allocation.
• Establish departmental goals and continuously assess and improve the performance of the departments in meeting these goals.
• Keep abreast of developments and changes in the healthcare environment, particularly relating to health plan members.
• Monitor management reports and other materials to assure that the departments are compliant with regulatory requirements and responsive to trends.
• As required, prepare oral and/or written reports and presentations at meetings.
• Interpret eligibility information from state, federal, and local agencies, and communicate this information understandably to others; Interact with staff and other HPSM departments regarding member eligibility problems and issues.
• Participate in department, management, and other meetings as requested by or approved by CSO; professionally represent Department and/or HPSM at internal and external meetings.
• Develop and update department policies and procedures, workflows, and resource materials.
• Implement policy and regulatory changes.
• Oversee production of weekly, monthly, and ad-hoc reports.
• Research and analyze membership trends and respond appropriately to negative variance.
• Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows.
• As needed, assist staff in handling of difficult phone calls, including complaint calls that may be transferred from staff.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don’t need to meet every requirement to apply.

Education and experience

• Bachelor’s degree in a health-related or business-related area is strongly preferred; direct work experience may substitute for education on a year-to-year basis. Minimum of two (2) years’ experience in a supervisory capacity
• Five (5) years of increasingly responsible experience in Member Services, health care or managed care setting which, includes working directly with patients/clients/members
• Managing phone-based customer service highly preferred
• Working with the needs of persons with disabilities, a low income, diverse population and/or senior is preferred

• Working with community partners, public agencies, and/or government programs is preferred, especially recent California-based experience

Knowledge of:

• Process improvement methodologies
• Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, Access and PowerPoint

• Medicare and/or Medi-Cal programs preferred
• Phone systems and call documentation systems highly preferred
• Supervisory principles and practices as well as techniques and methods to organize and manage direct reports

Ability to:

• Analyze data to identify trends and determine root cause
• Identify areas for process improvement and implement workflows
• Work collaboratively with other business partners
• Work as part of a team and support team decisions
• Communicate effectively, both verbally and in writing
• Adapt to changes in requirements/priorities for daily and specialized tasks
• Supervise and motivate staff
• Communicate effectively orally and in writing

Salary and benefits

The starting salary range depends on the candidate’s work experience.

Excellent benefits package includes:

• HPSM-paid premiums for employee’s medical, dental and vision coverage (employee pays 10% of each dependent’s premiums)
• Fully paid life, AD&D and LTD insurance
• Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
• 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
• Tuition reimbursement plan
• Employee wellness program

To apply, submit a resume to careers@hpsm . org.

Health Plan of San Mateo (HPSM) is a local County-funded nonprofit manages the health care for over 140,000 low-income people San Mateo County, including all its Medi-Cal eligible residents. HPSM is proud to be an Equal Opportunity Employer and an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status.

Job Type: Full-time

Pay: $85,000.00 - $110,000.00 per year

Benefits:

• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• Please do not apply unless you reside in California.

Experience:

• medicaid: 3 years (Required)
• Call center management: 3 years (Required)

Language:

• another language (Preferred)

Work Location: Hybrid remote in South San Francisco, CA 94080

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